Viewing entries tagged
pregnant athlete

Pregnant Athlete: Dispelling Myths Series #6

You must wait six weeks after birth to return to exercise.

FALSE

 

"I've been cleared to exercise!" are often the elated words of a new mom who is an athlete. This statement always stumps me: Is someone besides you in charge of what you do with your body? What good does abdicating responsibility for your own health do for you or your baby? Further, what does 'cleared' actually mean?

Oftentimes, new moms, following the word of their well-intentioned medical practitioner, remain relatively sedentary throughout pregnancy until six weeks postpartum when they get the magickal approval to return to training. Then they re-immerse in their training as though no time had passed since the last time they trained in earnest resulting in prolapse, exacerbated abdominal and pelvic floor weakness, general frustration, and a loss of confidence in their athletic ability postpartum. 

According to a 2014 peer-reviewed article:

Postpartum physical activity can improve mood, maintain cardiorespiratory fitness, improve weight control, promote weight loss, and reduce depression and anxiety.
— Evanson et al, "Summary of International Guidelines for Physical Activity Following Pregnancy"

Despite this motivating statement about the importance of exercise soon after giving birth, most women wait until their six-week postpartum checkup to discuss exercise with their doctors. According to the ACOG, about 40% of women decline a postpartum visit at all leaving them to wonder about when they might be ready to return to exercise. Additionally, the ACOG advises that women seek their postpartum visit between four and six weeks which means that many if not most women under the current model would be "cleared" for exercise much sooner than six weeks if they heeded these new guidelines.

Curiously, the ACOG cites no scientific evidence to support the timing of that postpartum visit instead relying on "cultural traditions" which, in my opinion, are a sorry means by which to govern health care.

The comprehensive postpartum visit has typically been scheduled between 4 weeks and 6 weeks after delivery, a time frame that likely reflects cultural traditions of 40 days of convalescence for women and their infants
— ACOG "Optimizing Postpartum Care"

Let's put aside the current model of care for a moment and think through empowering ourselves to make decisions about our bodies. Whether your care provider deems you ready for exercise or not, you are the ultimate authority on your body. Depending on your birth, your level of fitness throughout pregnancy, and how you feel your recovery is going, you might not feel ready to start training again until ten or twelve weeks postpartum or as early as the day after giving birth. I went into labor while climbing and returned to take lead falls a couple days after birthing my daughter which sped rather than hindered my recovery.

When I coach athletes through pregnancy and postpartum, they all perform differently but they all return to training much sooner than six weeks postpartum. They do this of their own accord, not at my urging. They learn through our coaching engagement to listen to the subtle cues their bodies give them about wellness and readiness to train which is a vital skill for endurance athlete whether pregnant or not. Most new moms I work with return to the gym within two weeks postpartum. They first test their bodies by doing brief, light, low-commitment sessions before progressing on to more intense or longer sessions. Precisely zero of my postpartum clients has experienced a negative outcome to their health or their breastfeeding status by returning to training this soon after giving birth. The key here is a phased reentry into training, not being sedentary for six weeks then overtraining.

So often women are conditioned by the medical system and other women (mom shaming much?) to adhere to a socially-accepted range of normal. The reality is that pregnancy, birth, and postpartum are likely to go differently for a professional athlete than they are for a weekend warrior, different as well for a mindful mover versus a dissociative athlete. The point is that the range of normal is huge spanning the luxuriously slow pregnancy some women dream of to the ultra-endurance pregnancy I had - and they are all correct and healthy ways to conduct pregnancy.

What women deserve is evidence and options so that they can make their own informed decisions about what is right for them. So before you wait to return to exercise until some doctor tells you it is 'safe', check in with your own body and ask it what is appropriate. A gradual return to training might make the difference between positive mental health and a dive into postpartum depression.

 

Read more:

My postpartum experience

Postpartum running

Postpartum climbing

Paige Reyes client interview

Postpartum body

 

Pregnant Athlete: Dispelling Myths Series #5

Exercising in the heat will damage your fetus.

FALSE.

 

Specific to summertime, preggos often hear this silly, parroted myth. Sources from WebMD to Babycenter pick up the thread, repeating this woman-negative, anti-scientific blather. Addionally, ACOG has recommended that women not exercise in the heat - citing insufficient evidence. Their issue with evidence isn't the lack of its existence but rather their use of twenty-five year old papers.

In order to potentially harm the fetus a mother's body temperature must exceed 102F - and I dare you to try and exercise hard enough to induce that kind of fever. The idea that exercise could raise the mother's body temperature to a level that may harm her child is untrue:

Of the limited studies of exercising pregnant women, there are no data suggesting that normal women actually exercise to a level of exertion that causes significant hyperthermia. However, these studies have been limited to nonathletic populations, in which the exercise has not been prolonged and of high intensity, or sufficient to induce dehydration.
— Murray/Katz "Thermoregulation In Pregnancy" (https://link.springer.com/article/10.2165/00007256-199010030-00002)

As I've discovered in the rest of my research on current pregnant athletic mythology, the myth is not only false, it couldn't be farther from the alchemic truth of the pregnant body's capabilities.

Pregnant women have improved heat-dissipating ability, which is enhanced further with exercise conditioning.
— Hammer/Perkins/Parr "Exercising During the Childbearing Year" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595006/)

Wait a tick... how the heck does that work given we've all been told that a pregnant woman will overheat more quickly? As it turns out, the same pregnant physiology that makes pregnancy function like blood doping AND the way heat training increases heat and cold tolerance (increase in plasma volume) also allows the pregnant body to more-efficiently dispel heat during exercise. Pretty neat!

So, next time the 100s plant themselves in your town and you want to take your round, strong, pregnant ass out for a run or ride hydrate up, wear your tiniest shorts, and hit the trails - fear-free.

Pregnant Athlete: Dispelling Myths Series, #4

A pregnant athlete should expect to recover more slowly from her workouts.

FALSE.

 

Increased stem cell activity initiated by the fetus in its mother's body has a two-fold positive affect on the recovering pregnant athlete's body: 1. Faster recovery from injuries and 2. Increased rates of angiogenesis.

Something NFL athletes have known, and exploited, for quite some time is that increased stem cell activity reduces their recovery time from injuries and surgeries. In particular tendon injuries seem to see a healing burst as a result of increased stem cell activity. By better understanding the meaning and utility of exercise, one can also extrapolate the importance of a boost in stem cell activity in recovery from particularly strenuous exercise.

Bones and tissue in our bodies are constantly breaking down and replacing themselves. During exercise, bone and muscle tissue breaks down as an adaptation to the applied stimulus and is replaced by stronger material. The faster this process can occur, the faster the athlete can recover, the more stimuli can be stacked close to one another, the stronger the athlete can feasibly become.

By thinking about recovery from weight-bearing and endurance exercise as the need for tissue regeneration it is easy to understand why, when I was pregnant, it was near-impossible to become sore from a workout and I felt my recovery time had decreased. It is also good to note that one major aim of endurance training is to induce higher rates of angiogenesis, or endothelial cell proliferation and an increase in capillary blood vessels.

Enter fetal-maternal microchimerism (also known as fetomaternal microchimerism or FMc). According to Zhong and Weiner's 2007 study on pregnant mice:

Fetal stem cells appear to respond to maternal injury signals and may play a role in maternal tissue regeneration during pregnancy. Massive new blood vessels were formed around the injury site which indicated the incidence of high angiogenesis events during the recovery of the skin injury. 

In an even more mind-boggling turn, the fetus continues to supply stem cell support to its mother even after it has departed from her body.

Fetal cells have also been identified in skin lesions of women with systemic sclerosis, a disease of unknown origin which often occurs in women after their child-bearing years.

This boost in FMc continues for quite some time according to Bianchi et al

In humans, PAPCs (pregnancy associated proginator cells) have been described to persist in mothers almost three decades postpartum.

 

This means that recovery times decrease and the injury-assisting qualities of fetal stem cell activity increase in the maternal body even after pregnancy. Now that is some rad sci-fi shit I couldn't dream up if I tried.

If you're into doing research on this sort of thing, doctors, please do us ladies a favor and dig deeper on the topic than I was able to do in this article. You owe it to preggos everywhere. Those burly NFL players only wish they could be pregnant athletes.

source

Pregnant Athlete: Dispelling Myths Series, #3

A pregnant woman should eat for two.

FALSE.

 

In an odd turn of events, What To Expect actually gets this one right. A 2002 Institute of Medicine study advises:

No additional calories for the first trimester, 340 kilocalories (per day) the second trimester, and 452 kilocalories (per day) for the third trimester.

That said, recommendations vary based on maternal BMI and pre-pregnancy nutritional status. It is also interesting to note:

Hytten (1980) estimated the energy cost of pregnancy to be 85,000 kcal.

That is the equivalent of 425 Larabars! Amazing. Good thing the preggo has ten months to eat that much extra food.

Also:

Energy requirements are greatest between 10 and 30 weeks of gestation, when relatively large quantities of maternal fat normally are deposited. Substantial fetal demands (56 kcal/kg per day) are offset in the last quarter of pregnancy by the near cessation of maternal fat storage (Sparks et al., 1980).

In an interesting parallel, premenstrual women have increased caloric needs that outstrip the increased caloric needs of their premenstrual peers. Check out this excerpt from a study on basal metabolic rates throughout a woman's menstrual cycle. In the premenstrual period, scientists found:

RMR was 0.99 +/- 0.16 kcal/kg/h. The energy expenditure while sitting was 1.06 times RMR, while walking it was 2.81 times RMR, and while performing treadmill exercise it was 3.47 times RMR.

This means that your increased interest in ALL THE FOOD is far more (metabolically) appropriate in the days preceding your period than it is during pregnancy. Of course, what you need to eat and what you want to eat are often different things and this is not a prescription about how you must eat. Use these data to make choices about how you eat and I urge you to not read into this data-oriented post any sort of shame about how you should eat while pregnant. If you read this and decide to eat more than you need or differently than what is simply nutrient-oriented, that is your prerogative. When you do indulge, enjoy.

So next time someone shames you for how you eat or look, tell them to step off - and share a bit of hard science. After all, science is the most effective antidote to misogyny.

source

Pregnant Athlete: Dispelling Myths Series, #2

A pregnant woman's immune system is suppressed throughout pregnancy.

FALSE.

 

In sources as diverse as the ever-incorrect What To Expect When You're Expecting to Science Daily, people positioned as experts on pregnancy trot out the same fallacy about womens' delicate immune systems. As you likely gathered from my previous post on this topic, advice that runs contrary to scientific fact (as established by peer-reviewed research) just rankles me.

So instead of continue to allow misogynists like What To Expect and Science Daily to treat the female physiology as though it were some fragile instrument, I'll allow an excerpt from Gil Mor and Ingrid Cardenas' 2011 paper entitled "The Immune System in Pregnancy: A Unique Complexity" to do the talking:

Is the systemic immunity of the mother suppressed? Although we can find numerous studies describing the factors inducing immune suppression (including progesterone, defined as the natural immune suppressor), medical and evolutionary aspects are against the concept of immune suppression. Pregnancy represents the most important period for the conservation of the species, therefore it is fundamental to strengthen all the means to protect the mother and the offspring. The immune system is one of the most important systems protecting the mother against the environment and preventing damage to the fetus. It is during pregnancy when the maternal immune system is characterized by a reinforced network of recognition, communication, trafficking and repair; it is able to raise the alarm, if necessary, to maintain the well-being of the mother and the fetus. On the other side is the fetus that, without any doubt, provides a developing active immune system that will modify the way the mother responds to the environment, providing the uniqueness of the immune system during pregnancy. Therefore, it is appropriate to refer to pregnancy as a unique immune condition that is modulated, but not suppressed.

This unique behavior explains why pregnant women respond differently to the presence of microorganisms or its products. Therefore, pregnancy should not imply more susceptibility to infectious diseases, instead there is a modulation of the immune system which leads to differential responses depending not only on the microorganisms, but on the stages of the pregnancy.

 

So, instead of continuing to falsely believe in maternal immune system suppression, let's begin to rethink the function of the altered immune system during pregnancy. The changes a mother's body experiences during pregnancy in fact allows a more sophisticated immune response and deeper cellular-level discernment in the face of immunologic threats.

This doesn't sound weak to me, this sounds downright superhuman.

 

Pregnant Athlete: Dispelling Myths Series #1

Pregnant athletes should keep their heart rate under 140bpm.

FALSE.

 

Though the incident, a final among many, that prompted me to write this salient and super popular series happened over two years ago now, I still hear from folks who have heard me interviewed on podcasts about this material, I use it in every coaching engagement with pregnant athletes, and I get weekly emails from pregnant athletes around the globe asking about this body of work. Hence, I’m reissuing the series one more time before translating it into a book.

So, here’s what happened: Another experienced athletic coach and parent who lives in the same town as me started talking with my friend and me at the crag about my talk at Vertical World on pregnant athleticism. During the event my friend had asked a poignant question about stigma, motherhood, and double-standards when it comes to being a pregnant or mothering athlete. He had more to say about the woman shaming I faced during my own pregnancy.

But before he could finish his thoughts, the other coach cut in and said (in a sadly well-timed vignette of an exchange):

"There's nothing that special about you training through pregnancy, lots of women do it. The only thing you need to do is wear a heart rate monitor and make sure your heart rate doesn't go over 140."

She, being the vastly senior and more respected endurance coach, did not expect what I said next:

"Actually, that is not based in fact and has been rejected by evidence-based practitioners. There is no heart rate limit for pregnant athletes who are well-trained."

And the evidence is on my side - and on the side of any preggo willing to push it on her next run or climb. In fact, according to the Mayo Clinic:

"If you exercised regularly before pregnancy, there's no need to focus on your heart rate for exercise during pregnancy."

Further:

"There are so many rumors out there, some started or perpetuated by popular pregnancy books, others the result of old wives' tales or outdated advice, so that many women really are confused about what they can and can't do. People are still stuck on this heart rate issue, and it was never based on anything concrete,"

says high-risk pregnancy expert Laura Riley, MD, spokeswoman for the American College of Obstetricians and Gynecologists (ACOG) and author of Pregnancy: You and Your Baby. ACOG is infamous for its overly-conservative views as they pertain to exercise during pregnancy. That rote false-fact nearly everyone who trains or cares of preggos says is wrong. No science. No evidence. Like fake news is to politics, this platitude is manipulative propaganda designed to control and oppress.

I take it seriously when other coaches, especially women, espouse non-evidence-based, misogynistic, one-size-fits-all limits on womens' athletic activity while pregnant without doing the work of educating themselves first. As a coach I am responsible for finding the right balance between challenging my clients and keeping them safe. For me, a core function of being a coach is keeping myself up-to-date on the most recent exercise physiology literature. This coach, in direct conflict with her many decades of experience, merely parroted a platitude she'd heard other coaches and medical professionals say many times before without the critical examination limits such as these deserve.

Culture limits pregnant athletes out of fear rather than equipping them with the evidence they need to choose how they would like to conduct their pregnancies––and I’d rather govern my health using evidence than superstition and old wive’s tales.

I hope you enjoy the final post of this series in this space before they go the way of the book!

Brittany Raven

GUEST POST: Prenatal mental health

Dear readers,

As I prepare to work with another cohort of the Pregnant Athlete E-course, I’ve been wrestling with how to approach the topic of prenatal mental health. Most of us, by now, understand that many new parents struggle with postpartum depression and anxiety but we often don’t talk about mental health during pregnancy.

I had a significant bout with prenatal anxiety and, while I’m not yet ready to write about it, I wanted to share something on the topic. When Leia posted on her social media about her own work through prenatal anxiety I asked if she would pen her story for you, reader.

She DID and it is raw, beautiful, relatable, hopeful, and honest. Some of us use medicine, therapy, coping mechanisms, or other ways to manage our mental health; here’s to de-stigmatizing the decision to employ medicine as a means of supporting a healthy pregnancy.

Brittany Raven

PS: I care about your wellbeing. If you are having suicidal thoughts or are engaging in self-harm, please click the button below to find emergency support.


HAWK finish.jpg

Prenatal Mental Health, by Leia Anderson

There are lots of ways that we can self-identify. I identify as a mom - with a three year old son and another boy on the way. I am a runner, which is a huge part of my identity as it branches into running coach, race director, and instructor. I am a wife, who has a spouse that supports me on my running and momming adventures. These are the identities that I latch onto.  They’re positive and offer fulfilment. Unfortunately there’s also a large piece of me that struggles with anxiety. I do not enjoy identifying as a person with anxiety, but if I don’t own that piece, it risks the other positive identifiers that I claim.

Anxiety and depression are often hand holders. For me, anxiety is the largest struggle and it manifests in different ways. When I am at my worst, all of those positives, the things that I love, don’t make me feel good. I become what feels like a bad mom, a bad wife, and I stop enjoying running in the same way. I worry about everything. I over-analyze conversations and things that most people would never read into. I physically manifest symptoms like tightness in my chest. When I decided to seek out some help, it did not come naturally to me. Partially because I didn’t understand that the way I felt wasn't it normal. I’d always felt like that. I also listened to a lot of voices telling me that “nothing was actually wrong, and just stop worrying so much.”

About ten years ago I decided to start seeing a psychologist as a first step.Though even though it helped, it wasn’t quite enough. I had started running, and it became a great help, but also still not enough. After some time I was referred to a psychiatrist to discuss medicine.   This is one of the hardest things for me to accept. I do not want this kind of help. I want to be ok on my own. I want to find coping mechanisms that I can hold on to and that will fix everything for me and make me feel better. However, I am a much better, mom, wife, and runner on medication and I have had to come to terms with that. I still incorporate talk therapy as I need to. It’s not a constant, but it’s helpful to have when I need a little extra.  

A major struggle with medicine is determining whether or not to take it while you are pregnant and nursing. We talk a fair amount about postpartum depression, but we often don’t acknowledge how hard it is to actually just be pregnant.  There are the hormonal changes that can cause moods to alter or stress to rise. Then you may have coping mechanisms in place that no longer work to ease your stress, depression, or anxiety. For my first pregnancy I chose to get off of the medicine that I was taking at the time (Citalopram). I had a comfortable pregnancy, was thrilled to be able to run and work out as much as I was able to, and managed fairly well. I even thought that I might be able to stay off of the medicine once I had the baby.

I was so in love with our little boy and managed for several months. Then I started to struggle again. I stopped enjoying things like running, particularly group runs, which are a big part of my life. I was worried about keeping up or taking time away from family in ways that were completely disproportionate to the concerns. I talked to my doctor and started taking Citalopram again. I felt better, like myself.

Fast forward three years and we are expecting again. One of the problems is that there really isn't a lot of research out there that clearly outlines SSRIs (Selective serotonin reuptake inhibitors) and their impacts on pregnancy. Google becomes a tool for stirring up emotions. I was struggling with the balance of how I felt being off medicine with how worried I was about being on it. Again I decided to get off of medicine.

It did not go well.  Right before I got pregnant I ran a forty-eight hour race; it was one of the most successful races I have run and it was also the longest. So even though I was still running and strength training throughout this pregnancy, it was a huge let down from what I had been been doing right before this. I had a couple of stressful events happen and I was not handling things well.  I was pregnant and not eating or sleeping enough, which was causing another layer of anxiety because I was worried about that too. I was sucking it up to teach classes and work with my clients, and was a mess at home. I started seeing my psychologist again, and though it helped, nothing was really making me feel truly better. At around five months pregnant I talked to my doctor about getting back on medicine. She was kind and empathetic (I could also go on and on about why it’s important to find a doctor who you truly trust and connect with during your pregnancy) and recommended Zoloft during pregnancy.  

After a couple of weeks I started to feel better, and after about a month of being back on I was like my old self. I initially felt guilty for needing this. I know so many women who feel so broken asking for medicine. I totally understand. It’s the feeling that you are out of control or can’t manage on your own. For some people talk therapy and coping mechanisms are enough, but not everyone. When I am on my medicine, I feel like myself, or how I really identify.

I’m always amazed by how many people thank me for being open about this. I choose not to be ashamed, not to feel broken, but to feel stronger because I’ve asked for and gotten the help that I need. I’m far more excited about this pregnancy now that I’m in the third trimester because I feel better; I’m enjoying my family more and am okay with what I can manage on my runs. I’m glad that I didn’t try to wait until after I delivered to ask for the help that I needed. I believe I’m having a happier healthier pregnancy because of it.  


read more:

Expectful meditation app

Pregnant doctor/alpinist/skiier

Pregnant Athlete E-course

 
IMG_1136.jpeg

Leia Anderson is a running coach and co-owner of Team Sparkle Productions in Kansas City. Team Sparkle coaches individual runners, has group training programs, workshops, and races. She’s passionate about helping people find their love of running and safely grow in the sport.  

Find out more about her work here and follow her on Instagram here.

<— that is Leia during her forty-eight hour event!

Pregnant Athlete: when to stop

Clients often ask me when they are exercising during pregnancy what the concrete indicators are that they would be well-suited to stop.

Usually, I recommend that each client check in with their midwife or OB to discuss this but I’ve wanted a comprehensive resource to give my clients and followers on this topic. Despite the flaws in the rest of the report, the recently-released 2019 Canadian guidelines for pregnancy exercise has a great list on when to stop exercise to share here.

Reasons to stop physical activity and consult a healthcare provider

- Persistent excessive shortness of breath that does not resolve on rest.
- Severe chest pain.
- Regular and painful uterine contractions.
- Vaginal bleeding.
- Persistent loss of fluid from the vagina indicating rupture of the membranes.
- Persistent dizziness or faintness that does not resolve on rest.
— https://bjsm.bmj.com/content/52/21/1339

This list will still leave pregnant athletes puzzling at the difference between pre-term labor and Braxton Hicks (which, for the record, are not caused or alleviated by exercise). Though this list is useful and is a clear indicator of when to stop, my coaching equips my clients with the self-knowledge and personal monitoring tools so that their bodies are not in so much distress that they experience heart palpitations or membrane rupture before they know to curtail their workouts. Building tools of mindfulness benefits the athlete and their baby.

Brittany Raven

Pregnant Athlete E-course registration now open

Pregnant Athlete E-course
200.00
Quantity:
Buff Bump

Pregnant athletes!

It is time to drop the fear and to start training guided by evidence - and your own self-knowledge.

We will specifically cover tactics and exercises for progressing in your mountain running, climbing, and backcountry ski practices all ten months. I’ll weave in anecdotes from the pregnant clients I’ve coached, peer-reviewed science, and tales from my own pregnant to postpartum journey with my daughter, Rumi - including running two ultras, skiing the steeps, and sending my longtime sport climbing nemesis all while pregnant.

Using a mindful approach guided by science and practical exercises, we’ll develop your skills of self-assessment and your knowledge of how a healthy pregnancy progresses.

I’m looking forward to growing and training together.

Brittany Raven

My clients do incredible/brave/laudable shit

Though they are many, I'm admittedly not great about highlighting my clients' accomplishments. In truth this is because I regard each of their journeys as spirit-athletes to be so sacred, so individual, that I have a strict non-disclosure agreement between me and them. Their stories are theirs to tell—and theirs alone.

However, I felt a quick roundup of their work was long overdue. This list is not comprehensive but I thought it useful to share a few successes emblematic of the athletes I coach.

So, some cool stories from 2018 so far:

  • Recovered from septic knee injury to run longest run ever while six months pregnant.

  • Completed the X-Pyr event, flying a paraglider and running the span of the Pyrenees.

  • Ran first ultra—while four months pregnant.

  • Climbed first outdoor lead successfully at eight months postpartum.

  • Ran ten miles in the mountains, joyfully.

  • Completed first fifty miler—and fast.

  • Used mindfulness practice and personalized training plans to recover from guiding-induced hyperthyroidism.

It is also meaningful to me that none of my athletes sustain overuse injuries or become overtrained while under my coaching. They all report that lessons on mindful movement are their most treasured takeaways. This work brings me great joy—I am honored to work with every single one of these humans and the ones I didn't mention, too.